The vulvar vestibule (or vulval vestibule) is located between the labia minora. The orifice of the urinary tract (i.e., the urethral orifice) opens into it. The vaginal orifice is behind the vestibule. Its edge is marked by Hart's Line. Hart's Line is the line of change from vulvar skin to the smoother mucosa of the vulva.
Pain at the vulvar vestibule, and at the labia minora, is relatively common. A study by the University of Michigan Journal of Lower Genital Tract Disease: January 2004—Volume 8—Issue 1—pp 48-57 found that about 28% of women have experienced vulvar vestibular pain, and about 8% had the pain in the last 6 months. Some problems could also be due to the vaginal and vulvar dryness.
The human vagina is an elastic muscular canal that extends from the cervix to the vulva. The internal lining of the vagina consists of stratified squamous epithelium and beneath this lining is a layer of smooth muscle, which may contract during sexual intercourse and when giving birth.
The vagina is the connection between the superficial vulva to the cervix of the deep uterus. After menopause, the body produces less estrogen, which causes the vaginal walls to thin out significantly. Some women have severe pain during sexual intercourse or tampon use; severe pain while biking, exercising, or wearing tightly fitting clothing; redness and burning/stinging in the vestibular area and vaginal area; and a frequent urge to urinate.
This pain could be due to vulvar and vaginal atrophy and/or vulvar vestibulitis syndrome (VVS), which is a vaginal condition in which the skin and mucous secreting glands (known as lesser vestibular glands) in the skin become inflamed. This can affect the entire vaginal opening, but predominantly presents in the lower portion. Women of all ages and all levels of sexual activity can experience this uncomfortable condition. The exact cause of vulvar vestibulitis syndrome remains unknown, but researchers continue to work toward gaining more insight into the condition.
Certain factors have been identified as being associated with vulvar vestibulitis syndrome. They include chronic yeast infections, human papilloma virus, chronic bacterial infections, pH imbalance in the vagina (acid-based) and long-term use of irritants and chemicals (like spermicides, lubricants, soaps and detergents).
Others chronic inflammatory pathologies that led to dysuria (pain on urination) and dyspareunia (pain during intercourse) could also be cited, like sclero atrophic lichen that is a chronic inflammatory nature of the anogenital area affecting predominatly women and that is present with genital and extragenital manifestations and as a consequence vulvar region becomes atrophic.
Treatment of all these pathologies often involves steroidal ointments that are topically applied and decrease redness and discomfort. Other options include trichloracetic acid, which works by destroying irritated skin and encouraging the growth of healthy skin; injections of interferon, which helps to increase the body's natural reaction to infection; and, in some cases, surgery (either standard or laser) to remove specific areas of affected skin. In some cases a local or sytemic hormonal treatment could also be associated.